Writing in the Washington Post’s Outlook, Darshak Sanghavi uses the tragic case of Justin Hansen / Artyom Savelyev, sent back to Russia by his American adoptive mother, Torry Hansen, to discuss the unique case of orphans living in Russian institutions.

Sanghavi’s essay mentions the paper Rose Kreider and I wrote in Pediatrics last year, which reported higher than average rates of disabilities among children adopted from Russia and Eastern Europe, among other places. As I told Dr. Sanghavi (who is chief of pediatric cardiology at the University of Massachusetts medical school), mental disabilities in this population are often attributed to fetal alcohol exposure, the result of drinking patterns among poor Russian mothers.

However, Sanghavi believes the main problem is the caregiving model that prevails in Russian institutions.

These facilities offer a time capsule of a medicalized approach to child-rearing that was popular in the Unites States decades ago, before the critical importance of children’s attachment to their caregivers was widely recognized and before we realized how damaging orphanages can be.

Rather than neglect, these children suffer from over-medicalization and under-nurturing, he argues.

I’m not well aware of the research on this phenomenon, but I did hear a compelling presentation by Harvard’s Charles Nelson at this year’s Adoption Policy Conference. He shows convincingly — based on experimental data — that a group of Romanian children randomized into foster care from orphanages developed much better, and the effects were larger the earlier they left the orphanage. The presumption that family care is preferable was behind the U.S. transition to a foster care system decades ago.

Although my initial reaction was more or less like this one, I’m not really in a position to offer much on the Hansen family situation. But I did find Sanghavi’s piece to be an interesting way to widen the lens on the story.